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Small-bowel bacterial overgrowth in children with chronic diarrhea, abdominal pain, or both
D de Boissieu1, M Chaussain, J Badoual
1Service de Pédiatrie, Hôpital Saint Vincent de Paul, Paris, France.
Insights
Small-bowel bacterial overgrowth (SBBO) is a common cause of chronic digestive issues in children, particularly those under two. The glucose breath hydrogen test (BHT) effectively diagnoses SBBO, leading to successful treatment.
Area of Science:
- Pediatric Gastroenterology
- Microbiology
- Diagnostic Medicine
Background:
- Chronic digestive symptoms in children, including diarrhea and abdominal pain, can significantly impact quality of life.
- Small-bowel bacterial overgrowth (SBBO) is increasingly recognized as a potential underlying cause of these symptoms.
- Accurate and non-invasive diagnostic methods are crucial for timely intervention.
Purpose of the Study:
- To determine the prevalence of SBBO in a large cohort of children presenting with chronic digestive complaints.
- To evaluate the efficacy of the glucose breath hydrogen test (BHT) as a diagnostic tool for SBBO in this pediatric population.
- To assess the impact of SBBO diagnosis and subsequent treatment on symptom resolution.
Main Methods:
- A cohort of 53 children (2 months to 12 years) with chronic diarrhea, abdominal pain, or both underwent the glucose breath hydrogen test (BHT).
- SBBO was diagnosed by a specific increase in hydrogen concentration post-glucose load.
- Positive cases were treated with antibiotics, followed by repeat BHT; control and comparison groups were included.
Main Results:
- 34% of the pediatric cohort tested positive for SBBO via BHT.
- Children with positive BHT results were significantly younger and more likely to present with diarrhea, fetid stools, mucus, and flatulence.
- Fasting hydrogen levels were significantly elevated in children with SBBO compared to controls.
- Antibiotic treatment resulted in symptom resolution and BHT normalization.
Conclusions:
- SBBO is a frequent contributor to chronic digestive symptoms in children, especially those under two years of age.
- The glucose breath hydrogen test (BHT) is a simple, non-invasive, and effective method for diagnosing SBBO in children.
- Early recognition and treatment of SBBO in pediatric patients lead to significant clinical improvement.
Objective:
To evaluate the frequency of small-bowel bacterial overgrowth (SBBO) as a cause of chronic digestive symptoms in a large cohort of children, using the glucose breath hydrogen test (BHT).
Design:
Patients were 53 children (aged 2 months to 12 years) with chronic diarrhea, abdominal pain, or both. Diagnosis of SBBO was defined with a BHT by a change in H2 concentration of 10 ppm H2 or more in expired air after an oral glucose load. Patients with a positive BHT result were included in group 1 and treated with a combination of colistin and metronidazole for 10 days; a second BHT was performed 1 month later. Group 2 comprised patients with a negative BHT result. Group 3 (n = 15) was a control group of healthy subjects, and group 4 (n = 6) a comparison group of subjects with bacteriologically documented SBBO.
Results:
Eighteen patients (34%) had a positive BHT result and 35 a negative result. The BHT results were comparable in groups 1 and 4 and in groups 2 and 3, respectively. Fasting H2 levels were higher in group 1 than in groups 2 (p < 0.001) and 3 (p < 0.01). In group 1, children were younger than in group 2 (1 +/- 1 year vs 3.9 +/- 3 years; p < 0.001) and diarrhea was frequent (83%), but 17% of patients had abdominal pain alone. Fetid stools (p < 0.01), mucus in stools (p < 0.01), and flatulence (p < 0.05) were more frequent in group 1 than in group 2. Antibiotic treatment of children in group 1 led to a rapid disappearance of symptoms and normalization of BHT results.
Conclusion:
SBBO appears to be a frequent cause of chronic digestive symptoms in children, especially before the age of 2 years. The BHT provides a simple and noninvasive method of detecting it. The recognition of SBBO in children leads to effective treatment.